The power of the scriptures and the spiritual tradition of the Church conjunctively with cognitive therapy are crucial in the treatment plan for the committed Christian patient or counselee. Since earliest Christian times, the Holy Fathers have written on and studied the passions, [strong emotions] (italics mine). For example in the presentation of the treatment rationale, the patient can be given readings from St. Dorotheus of Gaza: "Disturbance is the movement and stirring of thoughts, which arouse and irritate the heart" (Philokalia, 1984-93)(italics mine).

What the fathers of he church call "movement and stirring of thoughts which arouse the heart" can be easily understood by the clinician to be very related to the automatic thoughts and the triggering of emotions discussed by cognitive-behavioral clinicians. Thus as the Christian patient goes through the "Cognitive treatment" identifying distorted cognitions and restructuring them, they are at the same time performing a "spiritual act." This process would be likely motivational for the Christian patient.

Falsehoods

"There are three different kinds of falsehood [distortions]: There is the man who lies in his mind [cognitions]; the man who lies in word [behavior]. The man who lies in mind is given to conjecture [distorted cognition] (Philokalia, et al. 1984-93)(italics mine). This leads the clinician to describe cognitive distortions using spiritual terminology. Despondency, often discussed by the church fathers, may be more meaningful that the psychological term "depression." A similar utilization would be the use of the term "agitation" instead of anxiety. This helps patients view the world using a spiritual perspective as well as serve to help the patients distinguish subtle differences in meaning of cognitive perspectives.

Cognitive Distortions

St. Paul's words may also be helpful to the patient: "When I was a child, I spoke like a child, I thought like a child, I reasoned like a child; when I became a man, I gave up childish ways." (1 Cor 13:11 RSV). This saying addresses the use of cognitive distortions. Children are likely to use cognitive distortions in their response to the world. The Christian patient learns that identifying and restructuring his or her cognitive distortions is a Christian act.

The teachings of St. Anthony the Great focus on the cause of evil that today we would consider to be a cognitive process: "The cause of all evil is delusion, self deception [cognitive distortions], and ignorance of God" (Philokalia, 1984-93) (italics mine). Once again clinicians will find St. Anthony's counsels helpful in providing a spiritual rationale for the patient identifying and restructuring cognitive distortions.

General Intellectual Capabilities

St. Maximos the Confessor tells us what is the outcome of faulty thinking: "When our intelligence is stupefied, the incensive power precipitate and desire mindless, and when ignorance, a domineering spirit and licentiousness govern the soul and then sin becomes a habit..." (Philokalia, 1984-93) This intervention serves to motivate the patient to work at using his or her intelligence and to think as clearly as possible to develop the healing process.

This increased functionality would also be the consequence of the words of St. Hesychios the Priest: "...our inmost intelligence [reason, non-distorted cognitions] will direct the passions [emotions] in a way that accords with God's will, for we shall have set it in charge of them. The brother of the Lord declares: 'He who does not lapse in his inmost intelligence is a perfect man, able also to bridle the body [behavior]." (Philokalia, 1984-93) (italics mine)

Spiritual and Psychological Growth

Spiritual and psychological growth becomes a motivating force for the committed Christian in psychotherapy. The observation of St. Maximos the Confessor this time may aid the patient in the reason to initiate change: "We accomplish things actively in so far as our intelligence [meaning non-distorted cognitions], whose natural task is to accomplish the virtues is active in us." (Philokalia, 1984-93) (italics mine) This will lead the patient to be more personally, socially, occupationally and spiritually functioning.

The clinician can help patient to challenge the distorted cognitions related to his or her dysfunctional emotional reactions. There are three challenging questions that lead to restructured cognitions: What is the evidence supporting the patient's cognitive distortions? Is there any other way to consider the event? And is it as bad as the patient believes the situation is? Once again, for the committed Christian, interweaving a spiritual dimension along with the traditional psychological approach from the Christian perspective, enables the Holy Spirit to work within the individual and helps ensure that the totality of the person, body, mind, and spirit participate in the healing process. For example, in treating anger, the clinician should be aware that the cognitive theme accompanying the distorted cognitions is significant intrusion. That is the patient considers his person or extensions of himself (loved ones, property etc.) to have been violated. Effective psychological treatment techniques include anger inoculation and management (Novaco, 1977, Tarvis, 1984), assertiveness (Rathus, 1973), and the "mental ruler" technique (Burns, 1980). Once again integration of a spiritual factor with the traditional methods can be effective for the committed Christian patient. Typically, clinicians can help patients to accept that anger has several effects including creating additional problems for the patient and his or her family. Anger also diminishes the patient's own effectiveness in dealing with the original issue. From a Christian psychospiritual perspective, the clinician would consider using some of the following Christian verses in providing psychotherapy or counseling.

3.3 Christian Scriptural Verses and Their General Use

The following passages from the Old or New Testament can help the clinician demonstrate to the Christian patient that the dysfunctional emotions are a barrier to spiritual growth and thus attenuating them may not only aid in spiritual growth but aid in the development of the patient's personal and interpersonal functioning.

"He who is slow to anger has great understanding, but he who has a hasty temper exalts folly." (Prov 14:29)

"A man of wrath stirs up strife, and a man given to anger causes much Transgression." (Prov. 29:22)

"A hot tempered man stirs up strife, but he who is slow to anger quiets Contention." (Prov. 15:18)

These scriptural texts address the collateral damage caused by anger as an expression of emotional reactivity.

The following Scriptural passages may help the Christian patient consider the added effects of both personal and spiritual growth and thus they would be an aid in motivating cognitive-behavioral change. The Apostles echo the teachings of Jesus and tell us what is required as Christians through the use of the following passages:

"For the anger of man does not work the righteousness of God" (Ja 1:19)

St. Paul tells the Ephesians: "Let all bitterness and wrath and anger and clamor and slander be put away from you..." (Eph 4:31)

The spiritual fathers have developed this theme. Abba Evagrius the Monk tells us about the effects of anger which may once again help in motivating the committed Christian patient: "Anger and hatred increase the excitation of the heart and mercy and meekness extinguish it." (Philokalia, 1984-93)

3.4 Christian Verses and Their Use With Anxiety

The dominant theme in anxiety is a perceived threat. The patient determines that some event or person will produce some harm to him/herself or to people and/or things he or she values. Even when the threat is realistic, often the anxiety-ridden patient will have unrealistic perception about factors related to the threatening event. For example, a patient who may be realistic about the threat of failing an exam may have unrealistic thoughts and images about the consequences to the failure (e.g. will never be able to get a job, he will not be appreciated by others, etc.). Helping the committed Christian patient understand and integrate the scriptures and the teachings of the church fathers into his or her schema may be of healing value when addressing anxiety related disorders.

A clinician may ask: Jesus say: "Therefore I tell you, do not be anxious about your life, what you shall eat or what you shall drink, nor about your body, what you shall put on. Is not life more that food, and the body more than clothing." (Mat 6:25) Thus, inviting the patient to have confidence in Jesus can be used to replace anxiety with Christian serenity. For the Christian patient, this may be termed 'Jesus efficacy."

For other patients, it may be helpful to point out to him or her how wasteful and useless anxiety can be. Beck and Ellis usually accomplish this by pointing out to patients the added problems they have when anxiety complicates their lives. St. Matthew tells us the words of Jesus pointing out that anxiety adds nothing of value to our lives. He points out a spiritual component that may also make up the rationale for anxiety treatment: "And which of you by being anxious can add one cubit to his span of life." (Mat 6:27)

In the cognitive treatment of anxiety, the patient is helped to work at changing those behaviors that can be changed while accepting those he or she cannot change. This is brought out in words of Jesus: "Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Let the day's own trouble be sufficient for the day." (Mat 6:34)

The Church Fathers also echo Jesus' words. St. Neilos the Ascetic tells us: "It is ungodly to pass one's whole life worrying about bodily things" (Philokalia, 1984-93) St. John of Karpathos states: "We should of no account wear ourselves out with anxiety over body needs. With our whole soul let us trust in God..." (Philokalia, 1984-93). He invites us to use faith in addition to our own human efforts to restructure the irrational cognitions producing anxiety, which should be of special help to the Christian patient. I had a conversation with a former monk and seminarian whose anxiety was at times unmanageable and who was very concerned that "cognitive-behavior therapy" was too secular and was not "Christian". After exposure to the passages of the Old and New Testaments and the teachings of the Church Fathers that did not contradict, but supported cognitive interventions, he felt much more at ease in treatment and the treatment process proceeded more efficaciously.

3.5 Christian Sayings and Their Use With Depression

Depression is an extremely debilitating mental disorder. It's general theme of significant loss and the negative view of the self prevents the patient from creating a complete union with God. Hopelessness tends to be followed by suicide and is often accompanied by severe depression. The sense of abandonment, which often felt by the depressed person, broadcasts isolation from mankind and from God as well. Feeling this vacuum, depressed individuals become particularly susceptible to despair, which according to Christian tradition is an unforgivable sin: that they are beyond salvation even by the Holy Spirit. Once again the spiritual dimension can be an integral part of healing for the Christian patient. The torments and suffering of Job, may help the Christian patient remember that when it appears that God may have abandoned us, so we too may cry out: "My eye has grown dim from grief [depression], it grows weak because of all my foes." (Job 17:7) (italics mine)

We may also remember what the prophet Jeremiah said: "I will set my eyes upon them for good, and I will bring them back to this land. I will build them up, and not tear them down; I will plant them, and not uproot them. I will give them a heart to know that I am the Lord; and they shall be my people and I will be their God, for they shall return to me with their whole heart." (24: 6,7)

Christians can identify their problems with the trials and tribulations of Job and Jeremiah. Though seemingly abandoned by God, He is with them. This can be of great comfort to the Christian patient.

St. John Cassian tells us that before we can be united to God we must first overcome depression: "But first we must struggle with the demon of dejection [depression] who casts the soul into despair. We must drive him from our hearts". (Philokalia, 1984-93) (italics mine)

St. John is well aware of the devastating effects of depression. He goes on: "It was this demon that did not allow Cain to repent after he had killed his brother, or Judas after he had betrayed his Master." (Philokalia, 1984-93)

Typically, a clinician will listen to the patient's unfortunate life experiences as these relate to their painful experience of depression. Doing so allows the patient to be more receptive to other favorable options or possibilities (Beck, 1976). Here, the clinician can add the spiritual dimension as a powerful tool to help address enhance the treatment of depression for committed Christians. The clinician can help the patient adopt the outlook of St. Paul: "We are afflicted in every way, but we are not crushed; perplexed, but not driven to despair." (2 Cor 4:8)

The clinician and the patient can pray the prayer of the psalmist: "The Lord is my rock, and my fortress, and my deliverer, my God, my rock, in whom I take refuge, my shield, and the horn of my salvation, my stronghold." (Ps 18:2)

The Church Fathers recognize depression as a problem that must be resolved and they have trust that God will be their "rock". Adding this spiritual outlook to the psychological efforts of the patients helps them to see that their efforts become integrated into the will of God and he will deliver them from the despair of depression. Once again Christian patients are motivated to avoid despair and to persevere with their treatment.